Provider Demographics
NPI:1053481176
Name:LEONARD STALLINGS MD & ASSOCIATES
Entity Type:Organization
Organization Name:LEONARD STALLINGS MD & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STALLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-265-4566
Mailing Address - Street 1:PO BOX 5128
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305
Mailing Address - Country:US
Mailing Address - Phone:773-265-4639
Mailing Address - Fax:773-265-4576
Practice Address - Street 1:5120 W JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-4332
Practice Address - Country:US
Practice Address - Phone:773-265-4566
Practice Address - Fax:773-265-4576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071417Medicaid
L59833Medicare ID - Type Unspecified
C45139Medicare UPIN